Sahmeddini Mohammad Ali, Taghizadehimani Ashkan, Khosravi Mohammad Bagher, Eghbal Mohammad Hossein
Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran.
Indian J Hematol Blood Transfus. 2020 Jul;36(3):505-511. doi: 10.1007/s12288-020-01260-5. Epub 2020 Feb 24.
An important challenge during orthotopic liver transplantation (OLT) is optimal coagulation management. There are diverse studies regarding effect of Mg sulfate on coagulation system. This study evaluates the impact of Mg sulfate on the coagulation parameters of the rotational thromboelastometry (ROTEM) in patients about to undergo OLT. In this randomized clinical trial, 60 patients who were going to undergo OLT were randomly allocated into two groups. In the Mg group, the patients received a 1.5 g infusion of Mg 5 min before the surgical incision. In the control group, patients received a physiological saline instead of Mg. Plasma Mg levels before and after the infusions were measured in both groups. Also, three ROTEM tests: EXTEM, INTEM and FIBTEM were performed before and after the infusions. Baseline mean plasma magnesium levels were within normal range in the control and Mg groups: 2.06 and 2.18 mg/dl, respectively. After magnesium therapy, the mean plasma Mg level in the Mg group increased to 2.78 mg/dl in compared to the control group that was 2.01 mg/dl ( < 0.000). Mean value of the clotting time (CT) in the magnesium group were significantly decreased from 129.50 ± 7.76, 381.86 ± 8.51 and 114.26 ± 6.80 to 86.13 ± 3.4, 209.33 ± 6.68 and 81.56 ± 5.01 in the EXTEM, INTEM, and FIBTEM respectively after intervention in the Mg group ( = 0.001). Among patients with end-stage liver diseases who have ROTEM evidence of hypocoagulability, magnesium could correct CT parameter of the ROTEM tests.
原位肝移植（OLT）过程中的一个重要挑战是优化凝血管理。关于硫酸镁对凝血系统的影响有多种研究。本研究评估硫酸镁对即将接受OLT患者的旋转血栓弹力图（ROTEM）凝血参数的影响。在这项随机临床试验中，60例即将接受OLT的患者被随机分为两组。在硫酸镁组中，患者在手术切口前5分钟接受1.5克硫酸镁输注。在对照组中，患者接受生理盐水而非硫酸镁。两组均测量输注前后的血浆镁水平。此外，在输注前后进行三项ROTEM检测：EXTEM、INTEM和FIBTEM。对照组和硫酸镁组的基线平均血浆镁水平均在正常范围内，分别为2.06和2.18毫克/分升。硫酸镁治疗后，硫酸镁组的平均血浆镁水平升至2.78毫克/分升，而对照组为2.01毫克/分升（<0.000）。硫酸镁组干预后，EXTEM、INTEM和FIBTEM的凝血时间（CT）平均值分别从129.50±7.76、381.86±8.51和114.26±6.80显著降至86.13±3.4、209.33±6.68和81.56±5.01（=0.001）。在有ROTEM低凝证据的终末期肝病患者中，镁可以纠正ROTEM检测的CT参数。
